NEBR PLACEMENT APPLICATION

In an effort to help us place your dog in an environment best suited to
his/her needs, please fill out the following questionnaire as completely and
honestly as possible.

Name
Date

Email AddressAddress Address2City State

Zip CodeCountry

Phone:DayEvening

Dog's Name Dog's Age

Dog's Sex:Altered?
yesno

Why are you giving up the dog?

General
Health of Dog (Include history of surgery, accidents, eye, ear or skin
problems).

When
was last DHLP-P booster?

When was
last rabies?

When was last
heartworm test?

Name of
heartworm medicine and last date given

Name, address, tel.# of veterinarian:

Where
did you get your bloodhound?(Name of breeder,pet store etc).

How
long have you owned the dog? (If you are not the original owner, please
explain)

Why
was dog given up if you are a subsequent owner?

Is
your yard fenced or is the dog kenneled or confined?

What
brand of food do you feed? How much?

Dog's Temperament And Behavior

How
would you best describe the temperament of the dog? (check all that apply)
puppyish,
active,timid, aggressive, independent, uncontrollable, confident, gentle, passive,demanding, defensive, reserved, shy.

Has this dog
ever bitten? Under what circumstances?

Does
this dog ever growl, bare his teeth, snap or nip? Under what conditions?

Do
you work?yesno If so, how many hours is the dog
left alone?

How does the dog
behave when left alone?

Is
the dog confined or allowed the run of the house?

Is the
dog housebroken?yesno

Does the dog bark excessively?
Under what conditions?

Is the dog destructive?....does he chew? dig? steal? soil? other?

How is
the dog in the car?

How is
the dog with children?

Can
this dog be unquestioningly trusted with infants and small children?

How
is this dog with visitors?

How
is this dog with strangers?

How
is this dog with other animals?

How
do you exercise this dog?

Is the dog
leash trained?yes
no

Obedience
trained?yesno

What commands does
this dog respond to?

What
should a new owner NOT do with this dog?

Before
this dog can be placed, he must be up to date on all inoculations and have a
current heartworm test. A donation is requested to help cover the cost of the
rescue program. We realize that every situation is different and our main
concern is for the welfare of the dog. Please feel free to voice your
concerns.

Upon reviewing this form NEBR will send you an application which will need
to be signed by you. We also require that the dog's medical history be sent to
us at that time. NorthEast Bloodhound Rescue will make every effort to place
this dog in a responsible home. Thank you for your cooperation.